Abstract
Objective: To measure the association between endometrial cancer risk and obesity at age 18 and recently, adult weight gain, diabetes mellitus and hypertension.
Methods: We performed a population-based, nationwide case–control study among postmenopausal women aged 50–74 years in Sweden, including 709 incident cases with histopathologically verified endometrial cancer and 3368 controls.
Results: Compared to lean women (recent body mass index (BMI), i.e. kg/m2 below 22.5), overweight women (recent BMI 28–29.99) had a 50% increase in risk for endometrial cancer (OR 1.5, 95% CI 1.0–2.1). Obese women (recent BMI 30–33.99) had a 3-fold increased risk (OR 2.9, 95% CI 2.0–4.0), and markedly obese women (recent BMI ≥ 34) a 6-fold increased risk (OR 6.3, 95% CI 4.2–9.5). The OR for Type 2 diabetes mellitus was 1.5 (95% CI 1.0–2.1) and for Type 1 diabetes mellitus it was 13.3 (3.1–56.4). The effect of recent BMI was similar for tumors having different degrees of differentiation and myometrial invasion, and did not vary with age, time since menopause, smoking status, diabetes mellitus, and use of contraceptives. Hypertension increased risk only among obese women. BMI at age 18, height, and adult weight change were not independent risk factors.
Conclusions: Recent overweight/obesity and diabetes mellitus (Types 1 and 2) are associated with endometrial cancer risk. Hypertension increases risk among obese women.
Similar content being viewed by others
References
World Cancer Research Fund and American Institute of Cancer Research. Endometrium (1997) Food, Nutrition and Prevention of Cancer: a global perspective. Washington, DC: American Institute for Cancer Research, pp. 294-300.
Hankinson SE, Willet WC, Manson JE, et al. (1995) Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women. J Natl Cancer Inst 87: 1297-1302.
Sho. SM, Newcomb PA (1998) Diabetes, body size, and risk of endometrial cancer. Am J Epidemiol 148: 234-240.
Brinton LA, Swanson CA (1992) Height and weight at various ages and risk of breast cancer. Ann Epidemiol 2: 597-609.
Magnusson C, Baron JA, Persson I, et al. (1998) Body size in different periods of life and breast cancer risk in post-menopausal women. Int J Cancer 76: 29-34.
Cummings SR, Nevitt MC, Browner WS, et al. (1995) Risk factors for hip fracture in white women. N Engl J Med 332: 767-773.
Grady D, Ernster VL (1996) Endometrial cancer. In: Schottenfeld D, Fraumeni JFJr, eds. Cancer Epidemiology and Prevention. 2nd edn. New York: Oxford University Press, pp. 1058-1108.
Breslow NE, Day NE (1980) Statistical Methods in Cancer Research. vol. 1: The Analysis of Case-Control Studies. Lyon: International Agency for Research on Cancer pp. 192-246.
Le Marchand L, Wilkens LR, Mi M-P (1991) Early-age body size, adult weight gain, and endometrial cancer risk. Int J Cancer 48: 807-811.
Shu XO, Brinton LA, Zheng W, et al. (1992) Relation of obesity, body fat distribution to endometrial cancer in Shanghai, China. Cancer Res 52: 3865-3870.
Swanson CA, Potischman N, Wilbanks GD, et al. (1993) Relation of endometrial cancer risk to past, contemporary body size and body fat distribution. Cancer Epidemiol Biomarkers Prevention 2: 321-327.
Olson SH, Trevisan M, Marshall JR, et al. (1995) Body mass index, weight gain, and risk of endometrial cancer. Nutr Cancer 23: 141-149.
Levi F, La Vecchia C, Negri E, Parazzini F, Francheschi S (1992) Body mass at different ages and subsequent endometrial cancer risk. Int J Cancer 50: 567-571.
Tornberg SA, Carstensen JM (1994) Relationship between Quetelet's index, cancer of the breast and female genital tract in 47,000 women followed for 25 years. Br J Cancer 69: 358-361.
La Vecchia FC, Parazzini F, Negri E, Fasoli M, Gentile A, Franceschi S (1991) Anthropometric indicators of endometrial cancer risk. Eur J Cancer 27: 487-490.
Huang Z, Hankinson SE, Colditz GA, et al. (1997) Dual ffeeffects of weight and weight gain on breast cancer risk. JAMA 278: 1407- 1411.
Stoll BA, Vatten LJ, Kvinnsland S (1994) Does early physical maturity in¯uence breast cancer risk? Acta Oncol 33: 171-176.
Levi F, Francheschi S, Negri E, La Vecchia C (1993) Dietary factors and the risk of endometrial cancer. Cancer 71: 3575-3581.
Henderson BE, Ross RK, Pike MC (1993) Hormonal chemoprevention of cancer in women. Science 259: 633-638.
Tretli S (1989) Height and weight in relation to breast cancer morbidity and mortality. A prospective study of 570,000 women in Norway. Int J Cancer 44: 23-30.
Ziegler RG, Hoover RN, Nomura AMY et al. (1996) Relative weight, weight change, height and breast cancer risk in Asian-American Women. J Natl Cancer Inst 88: 650-660.
De Stavola BL, Wang DY, Allen DS, et al. (1993) The association of height, weight, menstrual and reproductive events with breast cancer: results from two prospective studies form the island of Guernsey (United Kingdom). Cancer Causes Control 4: 331-340.
Vatten LJ, Kvikstad A, Nymoen EH (1992) Incidence and mortality of breast cancer related to body height and living during childhood and adolescence. Eur J Cancer 28: 128-131.
Pike MC, Spicer DV, Dahmoush L, Press MF (1993) Estrogens, progesterones, normal breast proliferation and breast cancer risk. Epidemiol Rev 15: 17-35.
Kaaks R (1996) Nutrition, hormones, and breast cancer: is insulin the missing link? Cancer Causes Control 7: 605-625.
Rutanen EM (1998) Insulin-like growth factors in endometrial function. Gynecol Endocrinol 12: 399-406.
Elwood JM, Cole P, Rothman KJ, Kaplan SD (1977) Epidemiology of endometrial cancer. J Natl Cancer Inst 59: 1055-1060.
Hoogerland DL, Buchler DA, Crowley JJ, Carr WF (1978) Estrogen use - risk of endometrial carcinoma. Gynecol Oncol 6: 451-458.
Hulka BS, Fowler WC Jr, Kaufman DG, et al. (1980) Estrogen and endometrial cancer: cases and two control groups from North Carolina. Am J Obstet Gynecol 137: 92-101.
Kelsey JL, Li Volsi VA, Holford TR, et al. (1982) A case-control study of cancer of the endometrium. Am J Epidemiol 116: 333-342.
O'Mara BA, Byers T, Schoenfeld E (1985) Diabetes mellitus and cancer risk: a multisite case-control study. J Chronic Dis 38: 435- 441.
Adami H-O, McLaughlin J, Ekbom A, et al. (1991) Cancer risk in patients with diabetes mellitus. Cancer Causes Control 2: 307-314.
La Vecchia C, Negri E, Franceschi S, D'Avanzo B, Boyle P (1994) A case-control study of diabetes mellitus and cancer risk. Br J Cancer 70: 950-953.
Maatela J, Aromaa A, Salmi T, Pohja M, Vuento M, Gronroos M (1994) The risk of endometrial cancer in diabetic and hypertensive patients: a nationwide record-linkage study in Finland. Ann Chir Gynaecol Suppl 208: 20-24.
Weiderpass E, Gridley G, Persson I, Nyren O, Ekbom A, Adami H-O (1997) Risk of endometrial and breast cancer in patients with diabetes mellitus. Int J Cancer 71: 360-363.
Troisi R, Potischman N, Hoover RN, Siiteri P, Brinton LA (1997) Insulin and endometrial cancer. Am J Epidemiol 146: 476-482.
International Agency for Research on Cancer (1999) Some Hormones, Postmenopausal Hormone Therapy, and Hormonal Contraception (2-9 June 1998). Monograph no. 72. Lyon: International Agency for Research on Cancer.
Gray LA Sr, Christopherson WM, Hoover RN (1977) Estrogens and endometrial carcinoma. Obstet Gynecol 49: 385-389.
Weiss NS, Farewell VT, Szekely DR, English DR, Kiviat N (1980) Oestrogen and endometrial cancer: ffeeffects of otehr risk factors in the association. Maturitas 2: 185-190.
Jelovsek FR, Hammond CB, Woodard BH, et al. (1980) Risk of exogenous estrogen therapy and endometrial cancer. Am J Obstet Gynecol 137: 85-91.
La Vecchia C, Decarli A, Fasoli M, Gentile A (1986) Nutrition and diet in the etiology of endometrial cancer. Cancer 57: 1248-1253.
Mack TM, Pike MC, Henderson BE, et al. (1976) Estrogens and endometrial cancer in a retirement community. N Engl J Med 294: 1262-1267.
Horwitz RI, Feinstein AR (1978) Alternative analytic methods for case-control studies of estrogens and endometrial cancer. N Engl J Med 299: 1089-1094.
Spengler RF, Clarke EA, Woolever CA, Newman AM, Osborn RW (1981) Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases. Am J Epidemiol 114: 497-506.
Ewertz M, Schou G, Boice JD Jr (1988) The joint ffeeffect of risk factors on endometrial cancer. Eur J Cancer 24: 189-194.
Must A, Willett WC, Dietz WH (1993) Remote recall of childhood height, weight and body build by elderly subjects. Am J Epidemiol 143: 56-64.
Breslow NE, Day NE (1987) Statistical Methods in Cancer Research. vol. 2: The Design and Analysis of Cohort Studies. Lyon: International Agency for Research on Cancer, pp. 41-42.
Kuskowska-Wolk A, Karlsson P, Stolt M, Rössner S (1989) The predictive validity of body mass index based on self-reported weight and height. Int J Obesity 13: 441-453.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Weiderpass, E., Persson, I., Adami, HO. et al. Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 11, 185–192 (2000). https://doi.org/10.1023/A:1008946825313
Issue Date:
DOI: https://doi.org/10.1023/A:1008946825313